Zhang Yun, Huang Yuling, Luo Mingming, Yuan Xingxing, Wang Xiaoping, Gong Changfei
Department of Radiation Oncology, Jiangxi Cancer Hospital, Jiangxi Clinical Research Center for Cancer, JXHC Key Laboratory of Tumor Microenvironment and Immunoregulation, Nanchang, Jiangxi, 330029, PR China.
Phys Eng Sci Med. 2025 Mar;48(1):103-110. doi: 10.1007/s13246-024-01493-y. Epub 2024 Nov 7.
Variability in plan quality of radiotherapy is commonly attributed to the planner's skill rather than technological parameters. While experienced planners can set reasonable parameters before optimization, less experienced planners face challenges. This study aimed to assess the quality of volumetric-modulated arc therapy (VMAT) in patients with left-sided breast cancer following breast-conserving surgery. Twenty-eight patients requiring whole-breast irradiation were randomly selected for inclusion. Each patient underwent two VMAT treatment plans: one optimized by an experienced planner (VMAT-EXP group) and the other designed by a less experienced planner using feasibility dose-volume histogram (FDVH) parameters from PlanIQ (VMAT-FDVH group). Both plans aimed to deliver a prescription dose of 50 Gy in 25 fractions to the planning target volume (PTV). Dosimetry parameters for the PTV and organs at risk (OARs) were compared between the two groups. Both the VMAT-EXP and VMAT-FDVH groups met the clinical plan goals for PTV and OARs. VMAT-FDVH demonstrated a PTV coverage and homogeneity comparable to those of VMAT-EXP. Compared to VMAT-EXP plans, VMAT-FDVH plans resulted in a significant reduction in the mean ipsilateral lung dose, with an average decrease of 0.9 Gy (8.5 Gy vs. 7.6 Gy, P < 0.001). The V5Gy and V20Gy of the ipsilateral lung were also reduced by 3.2% and 1.8%, respectively. Minor differences were observed in the heart, contralateral lung, breast, and liver. Personalized objectives derived from the feasibility DVH tool facilitated the generation of acceptable VMAT plans. Less experienced planners achieved lower doses to the ipsilateral lung while maintaining adequate target coverage and homogeneity. These findings suggest the potential for the effective use of VMAT in in patients with left-sided breast cancer following breast-conserving surgery, especially when guided by feasibility DVH parameters.
放射治疗计划质量的差异通常归因于计划者的技能而非技术参数。虽然经验丰富的计划者在优化前可以设置合理的参数，但经验较少的计划者面临挑战。本研究旨在评估保乳手术后左侧乳腺癌患者的容积调强弧形放疗（VMAT）质量。随机选择28例需要全乳照射的患者纳入研究。每位患者接受两个VMAT治疗计划：一个由经验丰富的计划者优化（VMAT-EXP组），另一个由经验较少的计划者使用来自PlanIQ的可行性剂量体积直方图（FDVH）参数设计（VMAT-FDVH组）。两个计划均旨在向计划靶区（PTV）给予25次分割、总量50 Gy的处方剂量。比较两组PTV和危及器官（OARs）的剂量学参数。VMAT-EXP组和VMAT-FDVH组均达到了PTV和OARs的临床计划目标。VMAT-FDVH显示出与VMAT-EXP相当的PTV覆盖和均匀性。与VMAT-EXP计划相比，VMAT-FDVH计划使同侧肺平均剂量显著降低，平均降低0.9 Gy（8.5 Gy对7.6 Gy，P＜0.001）。同侧肺的V5Gy和V20Gy也分别降低了3.2%和1.8%。在心脏、对侧肺、乳腺和肝脏方面观察到微小差异。源自可行性DVH工具的个性化目标有助于生成可接受的VMAT计划。经验较少的计划者在保持足够的靶区覆盖和均匀性的同时，降低了同侧肺的剂量。这些发现表明，在保乳手术后的左侧乳腺癌患者中有效使用VMAT具有潜力，尤其是在可行性DVH参数的指导下。
